Headache & Migraine

Migraine is likely if attacks are moderate to severe, often one-sided or throbbing, made worse by moving around, and come with nausea or with sensitivity to light and sound. Aura is not required for a diagnosis and most people with migraine do not get it. A headache diary kept over a few weeks, noting timing, duration, associated symptoms and any medication taken, is the single most useful thing you can bring to an appointment.

Usually not. Headache is diagnosed clinically, from the pattern of attacks and a normal neurological examination, and scanning everyone with headaches turns up incidental findings that cause anxiety without changing treatment. A scan is arranged when something in the history or examination genuinely points to a secondary cause. If one is needed, that is explained rather than simply ordered.

Taking acute headache medication too frequently, broadly on ten or more days a month for triptans, opioids or combination painkillers, or fifteen or more for simple painkillers, can turn intermittent headaches into a near-daily one. It is common and under-recognised, and it will not improve while the medication continues. Treatment involves withdrawing the overused medication, usually alongside starting a preventative, and headaches typically get worse for a short period before improving.

Preventatives are taken daily to reduce how often attacks happen, rather than to treat one that has started. Several classes are used, and the choice depends on your other health conditions, since some options treat two problems at once. They need several weeks at an adequate dose before they can be judged, which is why people often abandon them too early, and success is measured as a meaningful reduction in attack frequency rather than complete elimination.

It can, in both directions. Insufficient or irregular sleep is one of the most reliable migraine triggers, and untreated obstructive sleep apnoea characteristically causes headaches that are present on waking. Cluster headache attacks often occur at night. Because this clinic covers both neurology and sleep medicine, a headache that looks sleep-related can be assessed properly in the same appointment rather than referred on.

Migraine is around three times more common in women, and many people notice attacks clustering around menstruation or worsening through the perimenopause. Recognising a hormonal pattern matters, because it changes both the timing of preventative treatment and which options are appropriate. A diary that records attacks against your cycle makes this pattern visible when it might otherwise be missed.

Cluster headache is uncommon but severe, and is often misdiagnosed as sinus problems or migraine for years. The pattern is distinctive: intense pain around one eye lasting under three hours, often waking the person at the same time each night, with a red or watering eye and a blocked nostril on that side, occurring in bouts over weeks. It responds to specific acute and preventative treatments quite different from those used in migraine, so getting the diagnosis right matters a great deal.